Skip to main content
Log in

Trauma, Dissociation, and Opiate Use Disorder

  • Dissociation and Addictive Behaviors (J Billieux and A Schimmenti, Section Editors)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The objective of this article is to identify the role of opioid use among survivors of trauma and to characterize the dissociative functions associated with this class of substances. More precisely, this paper will evaluate if the biochemical impact of opioid substances, such as heroin, has particular psychological effects on traumatized users, pertinent to their emotional needs.

Recent Findings

Reviewed studies demonstrated not only that the vast majority of opioid use disorder (OUD) patients reported a history of childhood trauma but that dissociation played an important role in both the experience of opioid use and abstinence.

Summary

Traumatized individuals were more likely to report dissociative experiences during their opioid use (chemical dissociation) and were more likely to report dissociative experiences during abstinence. The small body of literature on the inter-relationship between opioid use disorder (OUD) and dissociation suggests that heroin produces powerful sensations that mimic psychogenic dissociation. It might therefore be employed when posttraumatic distress can no longer be regulated by psychogenic mechanisms and when it is available. Future research should explore if OUD treatment can be more efficient following effective resolution of trauma-related dissociation and underlying posttraumatic psychopathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Friedl MC, Draijer N. Dissociative disorders in Dutch psychiatric inpatients. Am J Psychiatry. 2000;157:1012–3. https://doi.org/10.1176/appi.ajp.157.6.1012.

    Article  CAS  PubMed  Google Scholar 

  2. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D. Prevalence of dissociative disorders in psychiatric outpatients. Am J Psychiatry. 2006;163:623–9. https://doi.org/10.1176/ajp.2006.163.4.623.

    Article  PubMed  Google Scholar 

  3. Lyssenko L, Schmahl C, Bockhacker L, Vonderlin R, Bohus M, Kleindienst N. Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. Am J Psychiatry. 2018;175(1):37–46. https://doi.org/10.1176/appi.ajp.2017.17010025.

    Article  PubMed  Google Scholar 

  4. Ross CA, Heber S, Norton GR, Anderson G, Anderson D, Barchet P. The dissociative disorders interview schedule: a structured interview. Dissociation. 1989;2(3):169–89.

    Google Scholar 

  5. Tamar-Gurol D, Sár V, Karadag F, Evren C, Karagoz M. Childhood emotional abuse, dissociation, and suicidality among patients with drug dependency in Turkey. Psychiatry Clin Neurosci. 2008;62:540–7. https://doi.org/10.1111/j.1440-1819.2008.01847.x.

    Article  PubMed  Google Scholar 

  6. Karadag F, Sár V, Tamar-Gurol D, Evren C, Karagoz M, Erkiran M. Dissociative disorders among inpatients with drug or alcohol dependency. J Clin Psychiatry. 2005;66:1247–53. https://doi.org/10.4088/JCP.v66n1007.

    Article  PubMed  Google Scholar 

  7. Najavitz L, Walsh M. Dissociation, PTSD, and substance abuse: an empirical study. J Trauma Dissociation. 2012;13(1):115–26. https://doi.org/10.1080/15299732.2011.608781.

    Article  Google Scholar 

  8. Schäfer I, Langeland W, Hissbach J, Luedecke C, Ohlmeier MD, Chodzinski C, et al. Childhood trauma, dissociation and posttraumatic stress disorder in patients with alcohol dependence, drug dependence or both – a multi-center study. Drug Alcohol Depend. 2010;109:84–9. https://doi.org/10.1016/j.drugalcdep.2009.12.012.

    Article  PubMed  Google Scholar 

  9. Schäfer I, Reininghaus U, Langeland W, Voss A, Zieger N, Haasen C, et al. Dissociative symptoms in alcohol dependent patients: associations with childhood trauma and substance abuse characteristics. Compr Psychiatry. 2007;48:539–45. https://doi.org/10.1016/j.comppsych.2007.05.013.

    Article  PubMed  Google Scholar 

  10. Merlin MD. Archaeological evidence for the tradition of psychoactive plant use in the old world. Econ Bot. 2013;57:295–323. https://doi.org/10.1663/0013-0001(2003)057%5B0295:AEFTTO%5D2.0.CO;2.

    Article  Google Scholar 

  11. Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clarck TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74.

    Article  PubMed  Google Scholar 

  12. Peters RJ, Yacoubian GS, Baumier ER, Ross MW, Johnson RJ. Heroin use among southern arrestees: regional findings form the arrestee drug abuse monitoring program. J Addict Offender Couns. 2002;22:50–6.

    Article  Google Scholar 

  13. Fisher GL, Harrison TC. Substance abuse. Needham Heights: Allyn & Bacon; 1977.

    Google Scholar 

  14. National Institute on Drug abuse (2018). Heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use. Accessed 20 Oct 2018.

  15. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Rev Psychiat. 2009;4(5):231–44. https://doi.org/10.3109/10673229709030550.

    Article  Google Scholar 

  16. Mills KL, Lynskey M, Teeson M, Ross J, Darke S. Post-traumatic stress disorder among people with heroin dependence in the Australian treatment outcome study (ATOS): prevalence and correlates. Drug Alcohol Depend. 2005;77:243–9. https://doi.org/10.1016/j.drugalcdep.2004.08.016.

    Article  PubMed  Google Scholar 

  17. Somer E, Avni R. Dissociative phenomena among recovering heroin users and their relationship to duration of abstinence. J Soc Work Pract. 2003;3:25–38. https://doi.org/10.1300/J160v03n01_03.

    Article  Google Scholar 

  18. Robins LN, Davis DH, Goodwin DW. Drug use by army enlisted men in Vietnam: a follow-up on their return home. Am J Epidemiol. 1974;99:235–49. https://doi.org/10.1093/oxfordjournals.aje.a121608.

    Article  CAS  PubMed  Google Scholar 

  19. Clark HW, Masson CL, Delucchi KL, Hall SM, Sees KL. Violent trauma events and drug abuse severity. J Subst Abus Treat. 2001;20:121–7. https://doi.org/10.1016/S0740-5472(00)00156-2.

    Article  CAS  Google Scholar 

  20. Mills KL, Marel C, Drake S, Ross J, Slade T, Teesson M. The long-term impact of post-traumatic stress disorder on recovery from heroin dependence. J Subst Abus Treat. 2018;89:60–6. https://doi.org/10.1016/j.jsat.2018.04.001.

    Article  Google Scholar 

  21. Kessler RC, Cram RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-UI-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997;54:313–32. https://doi.org/10.1001/archpsyc.1997.01830160031005.

    Article  CAS  PubMed  Google Scholar 

  22. Gray MJ, Litz BT, Hsu JL, Lombardo TW. Psychometric properties of the life events checklist. Assessment. 2004;11:330–41. https://doi.org/10.1177/1073191104269954.

    Article  PubMed  Google Scholar 

  23. • Horton GH, Diaz N, Peluso PR, Mullaney D, Weiner M, McIlveen JW. Heroin use among individuals who abuse substances in residential treatment. J Addict Offender Couns. 2009;29:81–95. https://doi.org/10.1002/j.2161-1874.2009.tb00047.x This study showed that dissociative symptoms were related to lifetime heroin use.

    Article  Google Scholar 

  24. •• Somer E. Opioid use disorder and dissociation. In: Dell PF, O’Neil JA, editors. Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge/Taylor & Francis Group; 2009. p. 511–8. This chapter explores the various connections between OUD and dissociation and provides qualitative evidence that people with OUD seek dissociative experiences in drug use.

    Google Scholar 

  25. Somer E, Abu Raya H. & Nsairy Slimaan. Maladaptive daydreaming among recovering substance use disorder patients: prevalence and mediation of the relationship between childhood trauma and dissociation. Int J Ment Heal Addict. (in press).

  26. Somer E. Prediction of abstinence from heroin addiction by childhood trauma, dissociation, and extent of psychological treatment. Addict Res Theory. 2003;11(5):339–48. https://doi.org/10.1080/1606635031000141102.

    Article  Google Scholar 

  27. Peles E, Adelson M, Seligman Z, Bloch M, Potik D, Schreiber S. Psychiatric comorbidity differences between women with history of childhood sexual abuse who are methadone-maintained former opiate addicts and non-addicts. Psychiatry Res. 2014;219:191–7. https://doi.org/10.1016/j.psychres.2014.05.003.

    Article  PubMed  Google Scholar 

  28. Peles E, Potik D, Schreiber S, Bloch M, Adelson M. Psychiatric comorbidity of patients on methadone maintenance treatment with a history of sexual abuse. Eur Neuropsychopharmacol. 2012;22:883–91. https://doi.org/10.1016/j.euroneuro.2012.04.002.

    Article  CAS  PubMed  Google Scholar 

  29. Somer E, Ross C, Kirshberg A, Shawahdy R, Ismail S. Dissociative disorders and possession experiences in Israel: a comparison of opiate use disorder patients battered Arab women and a non-clinical group. Transcult Psychiatry. 2015;52(1):58–73. https://doi.org/10.1177/1363461514552584.

    Article  PubMed  Google Scholar 

  30. Jaffe WB, Chu JA, Woody GE. Trauma, dissociation, and substance dependence in an adolescent male. Harvard Rev Psychiatry. 2009;17(1):60–7. https://doi.org/10.1080/10673220902735660.

    Article  Google Scholar 

  31. Somer E, Dolgin M, Saadon M. Validation of the Hebrew version of the dissociation experiences scale (H-DES) in Israel. J Trauma Dissociation. 2001;2(2):53–66. https://doi.org/10.1300/J229v02n02_05.

    Article  Google Scholar 

  32. •• Somer E, Altus L, Ginzburg K. Dissociative pasychopathology among opioid use disorder patients: exploring the “chemical dissociation” hypothesis. Compr Psychiatry. 2010;51:419–25. https://doi.org/10.1016/j.comppsych.2009.09.007 The findings of this support the chemical dissociation hypothesis of OUD by showing that detoxified OUD patients had higher levels of dissociation than outpatients on methadone maintenance therapy who still benefit from chemical dissociation.

    Article  PubMed  Google Scholar 

  33. Waller NG, Putnam FW, Carlson EB. Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychol Methods. 1996;1:300–21. https://doi.org/10.1037/1082-989X.1.3.300.

    Article  Google Scholar 

  34. Ross CA, Ellason JW. Discriminating among diagnostic categories using the dissociative disorders interview schedule. Psychol Rep. 2005;96:455–3. https://doi.org/10.2466/pr0.96.2.445-453.

    Article  Google Scholar 

  35. Ross CA, Schroeder E, Ness L. (2013). Dissociation and symptoms of culture-bound syndromes in North America: a preliminary study. J Trauma Dissociation. 2013;14:224–35.

    Article  PubMed  Google Scholar 

  36. Somer E, Lehrfeld J, Jopp DS, Bigelsen J. Development and validation of the maladaptive daydreaming scale (MDS). Conscious Cogn. 2016;39:77–91. https://doi.org/10.1016/j.concog.2015.12.001.

    Article  PubMed  Google Scholar 

  37. Kianpoor M, Bahredar MJ, Ommizade SJ. Comparing the level of dissociative experience in prisoners with and without opioid dependence disorder in shiraz and its relationship with other psychiatric disorders. Iran J Psychiatry Behav Sci. 2010;4(1):18–22.

    Google Scholar 

  38. • Kianpoor M, Bahredar MJ, Ommizade SJ. Comparing the level of dissociative experience in prisoners with and without opioid dependence disorder in shiraz and its relationship with other psychiatric disorders. Iran J Psychiatry Behav Sci. 2010;4(1):18–22 This study showed a relationship between dissociative symptoms and heroin use.

    Google Scholar 

  39. Carlson EB, Putnam FW. An update on the dissociative experiences scale. Dissociation. 1993;6(1):16–27.

    Google Scholar 

  40. Ghafarinezhad A, Rajabizadeh G, Shahriari V. Relationships between dissociative disorders and personality traits in opium addicts on methadone treatment. Addict Health. 2013;5(1–2):21–6.

    PubMed  PubMed Central  Google Scholar 

  41. Kianpoor M, Ghanizadeh A, Badiei H. The relationship between dissociative experiences and the success of treatment through abstinence from opioid-use disorders. Zahedan J Res Med Sci (ZJRMS). 2012;14(10):56–60.

    Google Scholar 

  42. Dunn GE, Paolo AM, Ryan JJ, Van Fleet J. Dissociative symptoms in a substance abuse population. Am J Psychiatry. 1993;150(7):1043–7.

    Article  CAS  PubMed  Google Scholar 

  43. Benishek D, Wichowski HC. Dissociation in adults with a diagnosis of substance abuse. Nurs Times. 2003;99(20):34–6.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eli Somer.

Ethics declarations

Conflict of Interest

The author declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Dissociation and Addictive Behaviors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Somer, E. Trauma, Dissociation, and Opiate Use Disorder. Curr Addict Rep 6, 15–20 (2019). https://doi.org/10.1007/s40429-019-0236-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-019-0236-0

Keywords

Navigation